u4_p1_m1

Views:
 
Category: Education
     
 

Presentation Description

No description available.

Comments

Presentation Transcript

TREAT PEDIATRIC EYE CONDITIONS:

1 TREAT PEDIATRIC EYE CONDITIONS Unit 4: Part 1 Module 1 Prepared by: C. Sargo RN (EC) Reviewed by: Maj. Quinn RN (EC)

REFERENCES:

2 REFERENCES Ophthalmology for the Primary Care Physician Toronto Sick Kids Manual Toronto Notes Lecture Notes From EO 012.01, 012.02, 012.03 Class handout

DIFFERENTIAL DIAGNOSIS RED EYE:

3 DIFFERENTIAL DIAGNOSIS RED EYE Ophthalmia neonatorum Conjunctivitis (bacterial, viral or allergic) Traumatic injury (e.g., corneal abrasion) Corneal infection/keratitis Foreign body Glaucoma Uveitis (iritis)( anterior) Preseptal and orbital cellulitis

ALGORHYTHM RED EYE DIFFERENTIAL DX:

4 ALGORHYTHM RED EYE DIFFERENTIAL DX

DANGER FEATURES- RED EYE:

5 DANGER FEATURES- RED EYE Severe pain (unilateral) Photophobia Reduced visual acuity/ persistent blurring Reduced ocular movement Ciliary flush Irregular corneal light reflection

DANGER FEATURES- RED EYE:

6 DANGER FEATURES- RED EYE Pupil non-reactive to direct light Corneal epithelial defect/opacity Exophthalmos Worsening symptoms after 2-3 days of Rx of a simple conjunctivitis Compromised host - neonate, contact lens wearer, immuno-suppressed patient

RED EYE - HISTORY :

7 RED EYE - HISTORY An accurate history is very important History may point to a systemic illness such as juvenile rheumatoid arthritis, IBD, sarcoidosis or the possibility of trauma Do OPPQQRST of presenting S&S Ask the child (if of an appropriate age) about visual acuity, pain on movement of the eye and contact with chemical agents or makeup (the last of which might indicate allergic conjunctivitis)

RED EYE- HISTORY :

8 RED EYE- HISTORY Ask about preceding viral URTI (which would indicate infectious conjunctivitis) Inquire about contact with others with “ pink eye” For newborns, inquire about the possibility of maternally acquired infections such as gonorrhea/chlamydia

PHYSICAL FINDINGS:

9 PHYSICAL FINDINGS Inspect both eyes for shape, symmetry Redness, swelling, drainage/crusting Carefully document any evidence of external trauma Assess visual acuity and pupillary reaction Examine the anterior segment of the globe with a small penlight, and use a fluorescent stain to assess for corneal abrasion or ulcers Assess ocular mobility by checking range of movement

CASE STUDY:

10 CASE STUDY 10 day old female infant 1 day Hx. of red, watery eyes No cough , no fever Born at term gestation, healthy pregnancy Birth weight 3238 gms, SVD, no complications No one else ill at home

CASE STUDY:

11 CASE STUDY Physical Examination T – 37.2, HR 120, RR 40 Eyes- bilateral conjunctival injection, small amount purulent discharge, bilateral red reflexes present Rest of CPX is normal

CASE STUDY:

12 CASE STUDY Differential diagnosis Laboratory tests

OPHTHALMIA NEONATORUM:

13 OPHTHALMIA NEONATORUM Moderate -Severe bacterial conjunctivitis in newborns <28 days of age This condition must be differentiated from the more common mild conjunctivitis

PowerPoint Presentation:

14 OPHTHALMIA NEONATORUM

OPHTHALMIA NEONATORUM:

15 OPHTHALMIA NEONATORUM Causes - Generally acquired from the maternal genital tract - Bacterial organisms include Chlamydia and Neisseria gonorrhea - Chlamydial infection is the more common cause of neonatal conjunctivitis - Less commonly, Hemophilus strains, Staphylococcus aureus, Streptococcus pneumoniae and other gram-negative organisms may be involved

OPHTHALMIA NEONATORUM:

16 OPHTHALMIA NEONATORUM History- depends on causative organism Gonorrhea - Generally presents early (day 3-5 of life) - Should be considered in any infant who presents with conjunctivitis at less than 2 weeks of age

OPHTHALMIA NEONATORUM:

17 OPHTHALMIA NEONATORUM Chlamydia Infection - Children present with a history of eye redness and discharge after incubation period of 1-2 weeks - Should be considered in any child who presents with conjunctivitis in the first 3 months of life and who does not respond to usual topical antibiotics for mild conjunctivitis

OPHTHALMIA NEONATORUM:

18 OPHTHALMIA NEONATORUM Physical Findings - The child may appear severely ill, but the physical findings are generally limited to the eye examination: - Edema or erythema of the conjunctiva - Purulent secretion - Eyelids may be stuck together secondary to the purulent secretions

OPHTHALMIA NEONATORUM:

19 OPHTHALMIA NEONATORUM Differential Diagnosis - Viral/chemical/ conjunctivitis - Trauma - Nasolacrimal duct obstruction (dacryostenosis)

OPHTHALMIA NEONATORUM:

20 OPHTHALMIA NEONATORUM Diagnostic Tests - Swab eyes/nasopharynx for culture and sensitivity, N. gonorrhoeae and Chlamydia Gram stain- for gonorrhea - It is important to rule out chlamydial infection by means of a Chlamydia antigen swab

OPHTHALMIA NEONATORUM:

21 OPHTHALMIA NEONATORUM Management -Prevention - Prevention of perinatally acquired infections through prenatal screening and through STD control by appropriate follow - up of infected mother and her partner - Routine prophylaxis with erythromycin ointment (Ilotycin; for all newborns at birth

OPHTHALMIA NEONATORUM:

22 OPHTHALMIA NEONATORUM Treatment for potential chlamydia infection if gram stain negative for GC – start: - Topical erythromycin eye ung tid Erythromycin ethylsuccinate suspension (EES-200), 40-50 mg/kg daily, divided qid, PO for 14-21 days Refer all cases of Chlamydia infection to ophthalmology if there is no improvement after 2 or 3 days of oral treatment Treat mother and partners

OPHTHALMIA NEONATORUM:

23 OPHTHALMIA NEONATORUM Refer all suspected cases of gonorrheal ophthalmia to a Ophthalmology immediately The child must usually be admitted to hospital for IV administration of antibiotics – ceftriaxone Assess child for other STD/STI e.g. chlamydia, syphilis Treat mother and partner(s)

OPHTHALMIA NEONATORUM:

24 OPHTHALMIA NEONATORUM Complications - Gonorrheal conjunctivitis (also known as GC conjunctivitis) may be fulminant, leading rapidly to extensive orbital infection and possibly blindness - Systemic infections, including blood, joint and CNS infections, may occur secondary to N. gonorrhoeae infection

CASE STUDY - RESOLUTION:

25 CASE STUDY - RESOLUTION Gram stain negative for GC Empiric Rx with oral erythromycin x 14 days Swab confirmed chlamydia infection Follow up swab post Rx

NASOLACRIMAL DUCTOBSTRUCTION –DACRYOSTENOSIS :

26 NASOLACRIMAL DUCTOBSTRUCTION – DACRYOSTENOSIS A congenital disorder of the lacrimal system characterized by blockage of the nasolacrimal duct Results in excessive tearing and mucopurulent discharge from the affected eye The condition occurs in approximately 2% to 6% of newborns Onset is usually within the first few weeks of life

NASOLACRIMAL DUCT OBSTRUCTION -DACRYOSTENOSIS:

27 NASOLACRIMAL DUCT OBSTRUCTION - DACRYOSTENOSIS Cause Persistence of a membrane at the lower end of the nasolacrimal duct results in incomplete canalization of the duct and its consequent obstruction

PowerPoint Presentation:

28 DACRYOSTENOSIS

NASOLACRIMAL DUCT OBSTRUCTION -DACRYOSTENOSIS:

29 NASOLACRIMAL DUCT OBSTRUCTION - DACRYOSTENOSIS History And Physical Findings - Tearing within the affected eye - Pooling or puddling of tears - Epiphora (frank overflow of tears) - Accumulation of mucoid or mucopurulent discharge in the affected eye, which results in crusting (usually evident upon awakening)

NASOLACRIMAL DUCT OBSTRUCTION -DACRYOSTENOSIS:

30 NASOLACRIMAL DUCT OBSTRUCTION - DACRYOSTENOSIS History And Physical Findings - Erythema or maceration of the skin under the eye - Expression of clear fluid or mucopurulent discharge which may be intermittent or continuous over several months URTI may exacerbate the condition - Usually unilateral but may be bilateral - Conjunctival erythema and irritation minimal

NASOLACRIMAL DUCT OBSTRUCTION -DACRYOSTENOSIS:

31 NASOLACRIMAL DUCT OBSTRUCTION - DACRYOSTENOSIS Complications Dacryocystitis: Pericystitis: - Mucocele: a bluish, subcutaneous mass below the medial canthal tendon - Periorbital cellulitis: inflammation around the ipsilateral eye (this is an eye emergency)

PowerPoint Presentation:

32 DACRYOADENITIS

NASOLACRIMAL DUCT OBSTRUCTION -DACRYOSTENOSIS:

33 NASOLACRIMAL DUCT OBSTRUCTION - DACRYOSTENOSIS Diagnostic Tests - Eye swab for culture and sensitivity (if purulent discharge present) Management - In 90% of cases, the condition resolves, with conservative management, once the child reaches 1 year of age. - Monitor for and prevent complications

NASOLACRIMAL DUCT OBSTRUCTION -DACRYOSTENOSIS:

34 NASOLACRIMAL DUCT OBSTRUCTION - DACRYOSTENOSIS Nonpharmacologic Interventions - Provide reassurance to parents or caregiver - Offer support and encouragement, as condition may take many months to resolve - Recommend nasolacrimal massage two or three times daily, followed by cleansing of the eyelid with warm water - Suggest gentle massage of lacrimal sac toward the nose, to clear the passage - Teach parents or caregiver the signs and symptoms of complications, and instruct them to report any that occur

PowerPoint Presentation:

35 NASOLACRIMAL DUCT OBSTRUCTION

NASOLACRIMAL DUCT OBSTRUCTION -DACRYOSTENOSIS:

36 NASOLACRIMAL DUCT OBSTRUCTION - DACRYOSTENOSIS Pharmacologic Interventions Topical antibiotics for mucopurulent drainage i.e. Erythromycin 0.5% eye ointment (Ilotycin) hs

NASOLACRIMAL DUCT OBSTRUCTION -DACRYOSTENOSIS:

37 NASOLACRIMAL DUCT OBSTRUCTION - DACRYOSTENOSIS Refer if the condition has not responded to conservative management by the time the child reaches 6 months of age or any time there are complications (e.g., dacryocystitis, preseptal /orbital cellulitis A surgery consult may be necessary for lacrimal probing, which may be repeated once or twice Definitive surgery is indicated if lacrimal probing (performed up to three times) fails to resolve the problem

CASE HISTORY:

38 CASE HISTORY 10 month old boy brought in by MOM Concerned that every time son looks to the side his eyes seem crossed No other eye s&S Otherwise child appears well and is growing/developing normally

CASE HISTORY:

39 CASE HISTORY EXAMINATION OF EYES Eyes appear widely spaced but aligned symmetrically Prominent epicanthal folds No S&S of inflammation/infection Bilateral red reflex present PERRLA EOM’s normal

CASE HISTORY:

40 CASE HISTORY What conditions can make eyes appear to be crossed? What tests can be done in an office setting to evaluate for crossed eyes in a child? Which infants with crossed eyes need referral for evaluation and RX?

STRABISMUS:

41 STRABISMUS An abnormality in the alignment of the eyes The classification of strabismus is complex On an etiologic basis, it may be paralytic or non-paralytic It can also be classified as congenital or acquired, intermittent or constant, or convergent or divergent

STRABISMUS:

42 STRABISMUS Pathogenesis - When the eyes are positioned so that an image falls on the fovea (the area of best visual acuity) of one eye, but not the other, the second eye will deviate so that the image falls on it’s fovea as well - This deviation may be up, down, in or out and results in strabismus.

STRABISMUS:

43 STRABISMUS Patterns of Deviation - Esotropia: both eyes converge medially (crossed eyes) - Esotrophia: one eye deviates medially - Exotrophia: one eye deviates laterally - Hypertrophia: one eye deviates upward - Hypotrophia: one eye deviates downward

MAIN TYPES STRABISMUS:

44 MAIN TYPES STRABISMUS Heterophoria - Intermittent (latent) tendency to misalignment. - Eyes deviate only under certain conditions (e.g., stress, fatigue, illness) - Common - May be associated with transient double vision, headaches, eye strain

MAIN TYPES STRABISMUS:

45 MAIN TYPES STRABISMUS Heterotropia - Constant misalignment of eyes - Occurs because normal fusional mechanisms are unable to control eye deviation - Child is unable to use both eyes to fixate on an object and learns to suppress the image in the deviating (non-fixating) eye

MAIN TYPES STRABISMUS:

46 MAIN TYPES STRABISMUS Heterotropia - Alternating : child uses either eye for fixating and the other eye deviates - Vision develops normally in both eyes because there is no preference for fixation - Consistent : one eye is used consistently for fixating, and the other eye consistently deviates - Child is prone to defective development of vision in the deviating eye (because of constant suppression of the visual image)

CAUSES OF STRABISMUS:

47 CAUSES OF STRABISMUS Paralytic - Weakness or paralysis of one or more ocular muscles - Deviation is asymmetric - Congenital: secondary to developmental defect in muscle or nerves or to congenital infection - Acquired: due to extraocular nerve palsies; indicates a serious underlying problem (e.g., fracture of facial bone, CNS tumor, neurodegenerative disease, myasthenia gravis, CNS infection)

CAUSES OF STRABISMUS:

48 CAUSES OF STRABISMUS Non-paralytic - Most common type of strabismus - Extraocular muscles and the nerves that control them are normal - Occasionally, this form may be secondary to underlying ocular or visual defects such as cataracts or refraction errors - Overall, seen in 3% of children

CAUSES OF STRABISMUS:

49 CAUSES OF STRABISMUS Pseudostrabismus - Young infants have a broad nasal bridge; therefore, less of the inner eye is seen, which may give the impression of squinting - Intermittent eye convergence (crossed eyes) in infants 3-4 months of age is usually normal but should be monitored. If it persists, the child should be evaluated by a physician

STRABISMUS:

50 STRABISMUS History - Family history (about 50% of cases are hereditary) - Constant or variable squint in one or both eyes - Squinting worse with fatigue or stress - Child tilts head or closes one eye (compensatory mechanisms for weak eye)

STRABISMUS:

51 STRABISMUS Physical Exam -assess the following: - Observe eyes for symmetry of position - Extraocular eye movements (by having child visually follow an object): watch for asymmetry of movement - Visual acuity (with Snellen or similar chart) - Assess alignment with the following two main techniques .

STRABISMUS:

52 STRABISMUS Assessment Techniques to assess alignment - Corneal Light Reflex Test (Hirschberg Test) - Direct a small, focal light toward the child's face, and observe the reflections in each cornea - If the eyes are aligned, the reflection should be on symmetric points of the corneas

STRABISMUS:

53 STRABISMUS Cover-Uncover Test - Child is asked to fix gaze on an object (toy, colored yarn) - Examiner covers an eye - Allowing time for the eyes to drift - Uncover the eye - Observe eye movements of the eye just uncovered - Normal alignment: no movement of either eye - Repeat procedure on opposite eye

STRABISMUS:

54 STRABISMUS Abnormal Cover/Uncover test responses - Phoria: - when deviating eye is covered, it tends to move - when the deviating eye is uncovered, the examiner can observe the eye resume it’s former position - movement is seen on uncovering the deviating eye

STRABISMUS:

55 STRABISMUS Abnormal Cover/Uncover test responses - Tropia: - when fixating eye is covered, the deviating (uncovered) eye moves - movement is seen on covering the deviating eye

PowerPoint Presentation:

56 STRABISMUS

PowerPoint Presentation:

57 STRABISMUS

PowerPoint Presentation:

58 STRABISMUS

STRABISMUS:

59 STRABISMUS Complications - Amblyopia

STRABISMUS:

60 STRABISMUS Management All children with fixed (paralytic) strabismus need urgent referral to ophthalmology particularly if the paralytic strabismus is acquired - A young infant with intermittent, non-paralytic strabismus may be kept under observation until he or she reaches 6 months of age, when referral may become necessary if no resolution occurs

CASE RESOLUTION:

61 CASE RESOLUTION Boys eyes appear to deviate Corneal light reflex and cover /uncover test were normal Wide nasal bridge and prominent epicanthal folds noted No family hx. of eye problems What is diagnosis and management?

CONGENITAL CATARACTS:

62 CONGENITAL CATARACTS Incidence is 1/250 Present as leukocoria ( white pupil) Partial or complete Unilateral Often associated with other ocular anomalies and developmental disabilities

PowerPoint Presentation:

63 CONGENITAL CATARACTS

AMBLYOPIA:

64 AMBLYOPIA Definition - Poor vision not correctable with eyeglasses - No known organic cause Epidemiology - Prevalence: 2-4% of Children - Occurs in children up to age 6 years

AMBLYOPIA:

65 AMBLYOPIA Etiologies - Strabismus (most common cause of amblyopia) - Misalignment of eyes - Anisometropia (Refractive Amblyopia) - Large difference in Refractive Error between eyes

AMBLYOPIA:

66 AMBLYOPIA Deprivation Amblyopia - Congenital Cataract - Retinoblastoma - Corneal scarring - Vitreous opacity - Severe Ptosis - Optic atrophy - Iatrogenic patching

AMBLYOPIA:

67 AMBLYOPIA Pathophysiology - Occurs in developmentally immature eye - During first 6 months of life acuity normally improves rapidly 20/400 => 20/80 - Eye fully matures by age 9 years Normal maturity - Requires clear, equal, aligned image for each eye

AMBLYOPIA:

68 AMBLYOPIA Conflicting data with - Strabismus (2 competing images) - Anisometropia (1 clear, 1 blurred image ) Brain suppresses information from the "bad" eye Continued suppression leads to permanent vision loss

AMBLYOPIA:

69 AMBLYOPIA Screening - Visual Acuity testing first done age 3 - Exam for associated ocular disease Management: Force child to use amblyopic eye - Patch "good", dominant eye (usual course) - Atropine to blur dominant eye Prognosis - Amblyopia irreversible after age 9 years

EYE INJURIES:

70 EYE INJURIES Review eye injuries and foreign body from EO012.03 No changes for Pediatrics Infants get corneal abrasions from scratching own eye accidentally- keep nails short Sunconjunctival hemorrhage – think trauma- child abuse--  “shaken baby syndrome”

EYE INJURIES:

71 EYE INJURIES Non Accidental Trauma/Shaken Baby Syndrome - Hallmark of diagnosis is retinal hemorrhage - Presence and severity of hemorrhages correlates well with level of brain injury - History of injury often vague and not well correlated with extent of injuries - Other findings associated with non- accidental injury include ecchymosis of lids, sub-conjunctival hemorrhages, and hyphema

PowerPoint Presentation:

72 CORNEAL ABRASION

PRESEPTAL CELULITIS:

73 PRESEPTAL CELULITIS Infection of the tissues anterior to the orbital septum Bacteria gain access to the tissues around the orbit through trauma, skin pustules, insect bites, URTIs, infections of the teeth and occasionally sinusitis

PRESEPTAL CELLULITIS:

74 PRESEPTAL CELLULITIS Commonest organisms - Hemophilus influenzae — very important in children <5 years old - Staphylococcus aureus - Streptococcus pyogenes

PRESEPTAL CELLULITIS:

75 PRESEPTAL CELLULITIS Etiology trauma to eye area insect bites to the eye area stye, chalazion, meibomitis frequently there is no antecedent history - systemic features, such as fever and irritability

PowerPoint Presentation:

76 PRESEPTAL CELLULITIS

PRESEPTAL CELLULITIS:

77 PRESEPTAL CELLULITIS Signs/Symptoms - Child may be febrile, ill-looking - No pain on movement of the eye - Normal visual acuity (if it can be assessed), EOM’s, pupils - Orbital edema and erythema - Discharge may be present

PRESEPTAL CELLULITIS:

78 PRESEPTAL CELLULITIS Differential Diagnosis - Orbital cellulitis COMPLICATIONS Orbital cellulitis - Diagnostic Tests - Swab any discharge for culture and sensitivity

PRESEPTAL CELLULITIS:

79 PRESEPTAL CELLULITIS Consult a physician for all cases Nonpharmacologic Interventions - Warm compresses qid - Explain to parents or caregiver the nature, course, expected treatment and outcomes of the disease - Counsel parents or caregiver about appropriate use of medications (dose, route, side effects)

PRESEPTAL CELLULITIS:

80 PRESEPTAL CELLULITIS Pharmacologic Interventions Topical antibiotic ointment e.g. sodium sulamyd Systemic antibiotics – Clavulin Follow up in 24-48 hours to assess response Advise immediate return if infection spreading

ORBITAL CELLULITIS:

81 ORBITAL CELLULITIS Bacterial infection of the deep tissues of the posterior orbital space Orbital cellulitis and preseptal cellulitis may coexist in the same person Usually a serious complication of acute sinusitis or other facial /dental infection or trauma Streptococcus pneumoniae Hemophilus influenzae (non-typable) Branhamella catarrhalis Staphylococcus (less common )

ORBITAL CELLULITIS:

82 ORBITAL CELLULITIS Symptoms/Signs Child may appear mildly ill to moribund, depending on severity of infection Fever – low-high grade Adenopathy - Inflammation and swelling of the surrounding orbital tissues and eyelids - Exophthalmos (proptosis) may be present in severe cases

PowerPoint Presentation:

83 ORBITAL CELLULITIS

ORBITAL CELLULITIS:

84 ORBITAL CELLULITIS Symptoms/Signs ( continued) - Mild to moderate ophthalmoplegia (inability to move eye) Mild to significant decrease in visual acuity Papilledema Assess for any neurological complications and level of consciousness (see pediatric Glasgow coma scale The significant eye findings e.g. decreased VA, proptois, inability to move eye , pain on eye movement etc. helps differentiate orbital cellulitis from prreseptal cellulitis

ORBITAL CELLULITIS:

85 ORBITAL CELLULITIS Complications - Intracranial cavernous sinus thrombosis (associated with signs of CNS irritation, puffiness of the face, deterioration in level of consciousness) - Orbital or subperiosteal abscess - Infection of other orbital structures - Meningitis - Intracranial abscess - Blindness

ORBITAL CELLULITIS:

86 ORBITAL CELLULITIS Diagnostic Tests Swab any discharge for culture and sensitivity before starting antibiotics Blood cultures x 3 CT of orbit

ORBITAL CELLULITIS:

87 ORBITAL CELLULITIS Management Urgent MD consult Admit/Urgent referral to hospital - IV antibiotics should be started urgently - Discuss choice of antibiotics with a physician - Antibiotic of choice: cefuroxime (Zinacef)

REFRACTIVE ERRORS:

88 REFRACTIVE ERRORS Normal vision - Develops over time from birth reaching maturity at age 9 Visual acuity in children - Birth 20/200 - Infants 6-12 months = 20/120 - 1-2 years = 20/80 2- 4 years = 20/30

REFRACTIVE ERRORS:

89 REFRACTIVE ERRORS At risk children for refractive errors; - Down’s syndrome - premature babies - offspring of parents with severe refractive errors

REFRACTIVE ERRORS:

90 REFRACTIVE ERRORS Myopia - presents in first decade- age 8 - commonest childhood refractive error - squinting to improve distance vision - headaches are a common compliant - globe too long, image falls in front of retina - blurring of distant vision - corrected with concave (-) lenses

PowerPoint Presentation:

91

REFRACTIVE ERRORS:

92 REFRACTIVE ERRORS Hyperopia - may be developmental or acquired - globe too short or refractive mechanisms weak - image falls behind retina without accommodation - near vision is blurred - children usually do not require glasses because they have sufficient accommodative ability to focus image on retina - diminishes around age 8 - corrected with convex (+) lenses

PowerPoint Presentation:

93

REFRACTIVE ERRORS:

94 REFRACTIVE ERRORS Astigmatism - light rays not uniformly refracted in all meridians - due to nonspherical shape of cornea or of lens - may lead to amblyopia if severe and not corrected at an early age - corrected with cylindrical lenses

PowerPoint Presentation:

95

PowerPoint Presentation:

96 ASTIGMATISM

CONGENITAL GLAUCOMA:

97 CONGENITAL GLAUCOMA Associated with other congenital syndromes such as Down’s Turner’s S&S – Decreased vision, photophobia Increased tearing during daylight or in bright light, Corneas hazy/cloudy, decreased corneal reflex Referral to Ophthalmology Medications, surgeries Good prognosis if picked up early, but is a lifelong condition

RETINOBLASTOMA:

98 RETINOBLASTOMA The average age of children with retinoblastoma is 18 months. More than 75% of children are first noted to have a “ white-pupil” leukocoria, or strabismus or a red and painful eye (usually due to glaucoma). CAT scans, and ultrasound can diagnose intraocular retinoblastomas in over 95% of cases.

RETINOBLASTOMA:

99 RETINOBLASTOMA Over the last 30 years, treatment has evolved from simple enucleation (removal of the eye), to eye-sparing radiotherapy, and more recently to chemotherapy-based multimodality therapy. Though retinoblastomas are usually cured by radiation, investigators have suggested that irradiation and chemotherapy increases the risk of developing second cancers later in life

authorStream Live Help